Control system and process for application of energy to airway walls and other mediums

ABSTRACT

The present disclosure may include a system for delivering energy to an airway wall of a lung comprising an energy delivering apparatus and a PID controller having one or more variable gain factors. The energy delivering apparatus may include a flexible elongated member and a distal expandable basket having at least one electrode for transferring energy to the airway wall and at least one temperature sensor for measuring temperature.

CROSS-REFERENCE TO RELATED APPLICATION(S)

The present application is a continuation of U.S. patent application Ser. No. 12/944,238, filed Nov. 11, 2010 (now U.S. Pat. No. 8,888,769), which is a continuation of U.S. patent application Ser. No. 11/458,074, filed Jul. 17, 2006 (now U.S. Pat. No. 7,854,734), which is a continuation of U.S. patent application Ser. No. 10/414,411, filed Apr. 14, 2003 (now U.S. Pat. No. 7,104,987), which claims priority to PCT Patent Application No. PCT/US01/32321, filed Oct. 17, 2001, each of which are incorporated by reference in its entirety. The present application is related to PCT Application No. PCT/US00/28745 filed Oct. 17, 2000 which is hereby incorporated by reference in its entirety.

TECHNICAL FIELD

This invention is related to systems for applying energy to lung airways and in particular, to a system and method for controlling the energy delivered to the airways using a PID algorithm to minimize error between a preset temperature and a measured temperature.

BACKGROUND

Various obstructive airway diseases have some reversible component. Examples include COPD and asthma. There are an estimated 10 million Americans afflicted with Asthma. Asthma is a disease in which bronchoconstriction, excessive mucus production, and inflammation and swelling of airways occur, causing widespread but variable airflow obstruction thereby making it difficult for the asthma sufferer to breathe. Asthma is a chronic disorder, primarily characterized by persistent airway inflammation. Asthma is further characterized by acute episodes of additional airway narrowing via contraction of hyper-responsive airway smooth muscle.

Reversible aspects of obstructive pulmonary disease generally include excessive mucus production in the bronchial tree. Usually, there is a general increase in bulk (hypertrophy) of the large bronchi and chronic inflammatory changes in the small airways. Excessive amounts of mucus are found in the airways and semisolid plugs of mucus may occlude some small bronchi. Also, the small airways are narrowed and show inflammatory changes. Reversible aspects include partial airway occlusion by excess secretions and airway narrowing secondary to smooth muscle contraction, bronchial wall edema and inflammation of the airways.

In asthma, chronic inflammatory processes in the airway play a central role in increasing the resistance to airflow within the lungs. Many cells and cellular elements are involved in the inflammatory process, particularly mast cells, eosinophils T lymphocytes, neutrophils, epithelial cells, and even airway smooth muscle itself. The reactions of these cells result in an associated increase in the existing sensitivity and hyper-responsiveness of the airway smooth muscle cells that line the airways to the particular stimuli involved.

The chronic nature of asthma can also lead to remodeling of the airway wall (i.e., structural changes such as thickening or edema) which can further affect the function of the airway wall and influence airway hyper-responsiveness. Other physiologic changes associated with asthma include excess mucus production, and if the asthma is severe, mucus plugging, as well as ongoing epithelial denudation and repair. Epithelial denudation exposes the underlying tissue to substances that would not normally come in contact with them, further reinforcing the cycle of cellular damage and inflammatory response.

In susceptible individuals, asthma symptoms include recurrent episodes of shortness of breath (dyspnea), wheezing, chest tightness, and cough. Currently, asthma is managed by a combination of stimulus avoidance and pharmacology.

Stimulus avoidance is accomplished via systematic identification and minimization of contact with each type of stimuli. It may, however, be impractical and not always helpful to avoid all potential stimuli.

Pharmacological management of asthma includes: (1) long term control through use of anti-inflammatories and long-acting bronchodilators and (2) short term management of acute exacerbations through use of short-acting bronchodilators. Both of these approaches require repeated and regular use of the prescribed drugs. High doses of corticosteroid anti-inflammatory drugs can have serious side effects that require careful management. In addition, some patients are resistant to steroid treatment. The difficulty involved in patient compliance with pharmacologic management and the difficulty of avoiding stimulus that triggers asthma are common barriers to successful asthma management. Current management techniques are thus neither completely successful nor free from side effects. Accordingly, it would be desirable to provide a system and method which improves airflow without the need for patient compliance.

Various energy delivering systems have been developed to intraluminally treat anatomical structures and lumen other than the lung airways. Unfortunately, the systems which are useful in treating such structures are generally not helpful in developing techniques to treat the lung airways because the lung airways are markedly different than other tissue structures. For example, lung airways are particularly heterogeneous. Variations in lung tissue structure occur for a number of reasons such as: the branching pattern of the tracheobronchial tree leads to local variation in the size and presence of airways; the vasculature of the lungs is a similar distributed network causing variation in size and presence of blood vessels; within the airways are variable amounts of differing structures such as cartilage, airway smooth muscle, and mucus glands and ducts; and energy delivery may also be influenced differently at the periphery, near the outer surface of a lung lobe, than in the central portion.

Lung airways also include a number of protruding folds. Other tissue structures such as blood vessels typically do not have the folds found in airways. Airways contain mucous and air whereas other structures contain different substances. The tissue chemistry between various lumens and airways is also different. In view of these differences, it is not surprising that conventional energy delivering systems cannot be universally applied to treat all tissue structures. Moreover, power shut-offs and other safety mechanisms must be precisely tailored to specific tissue so that the tissue is not harmed by application of excess energy.

Accordingly, an intraluminal RF energy delivering system that is capable of safely delivering RF energy to lung airways is desired. In particular, a system which is capable of controlling the temperature when treating an airway of an asthma or COPD patient is desired. It is also desirable to provide a system having built-in safeguards that shut the power off thereby preventing damage to the subject tissue or collateral tissue.

SUMMARY

The present invention includes a system for delivering energy to an airway wall of a lung comprising an energy delivering apparatus and a PID controller. The energy delivering apparatus may include a flexible elongated member and a distal expandable basket having at least one electrode for transferring energy to the airway wall and at least one temperature sensor for measuring temperature (TM) of the airway wall when energy is delivered to the airway wall. The system further comprises a PID controller for determining a new power set point (Pi+1) based on an error (e) between a preset temperature (TS) and the measured temperature wherein the PID controller applies an algorithm having a variable gain factor (G).

In one variation of the present invention, the algorithm is Pi+1=Pi+G (αei+βei−1+γei−2) where α, β and γ are preset values. For instance, in one variation of the present invention, α is from 1 to 2; β is from −1 to −2; and γ is from −0.5 to 0.5. In another variation of the present invention, α, β, γ are 1.6, −1.6, and 0.0 respectively.

In another variation of the present invention, the gain factor used in the PID algorithm is reset 0.1 to 2 seconds after energy delivery has begun. The gain factor can also be reset 0.5 seconds after energy delivery has begun. The invention includes resetting G to 0.9 to 1.0 if a temperature rise in ° C. per Joule is less than or equal to 2.5; 0.4 to 0.5 if a temperature rise in ° C. per Joule is between 2.5 to 5.0; to 0.2 to 0.3 if a temperature rise in ° C. per Joule is equal to 5.0 to 7.5; and to 0.1 to 0.2 if a temperature rise in ° C. per Joule is greater than 7.5. Initially, the gain factor is equal to 0.4 to 0.5 and preferably 0.45 to 0.47.

In another variation of the present invention, the PID algorithm is Pi+1=Pi+(G1ei+G2ei−1+G3ei−2) and G1, G2 and G3 are variable gain factors. The invention includes configuring the controller such that G1, G2 and G3 are reset to 0.9 to 2.00, −0.9 to −2.00 and 0.5 to −0.5 respectively if a temperature rise in ° C. per Joule is less than or equal to 2.5; to 0.40 to 1.00, −0.40 to −1.00 and 0.25 to −0.25 respectively if a temperature rise in ° C. per Joule is between 2.5 to 5.0; to 0.20 to 0.60, −0.20 to −0.60 and 0.15 to −0.15 respectively if a temperature rise in ° C. per Joule is equal to 5.0 to 7.5; and to 0.10 to 0.40, −0.10 to −0.40 and 0.10 to −0.10 respectively if a temperature rise in ° C. per Joule is greater than 7.5. Each of the variable gain factors may be equal to a product of at least one preset value and at least one variable value.

In another variation of the present invention, the controller is configured such that the energy delivery is terminated if the energy delivered exceeds a maximum energy such as 120 joules.

In another variation of the present invention, the controller is configured to deliver energy for an activation time period such as up to 15 seconds, 8 to 12 seconds, or 10 seconds.

In another variation of the present invention, the controller is configured such that Ts is set at a value between 60 to 80° C., or 65° C.

In another variation of the present invention, the controller is configured to measure impedance and said energy delivery is terminated when said impedance drops below a preset impedance value such as 40 to 60 ohms.

In another variation of the present invention, the controller is configured to terminate the energy delivery if TM exceeds TS by a pre-selected value such as 10, 15 or 20° C.

In another variation of the present invention, the controller is configured to terminate the energy delivery if the output power is greater or equal to a nominal output power and TM drops by a critical temperature difference within a sampling period. The invention includes a nominal output power set at a value of at least 17 watts; the sampling period is set at a value of at least 0.5 seconds; and the critical temperature difference is 2° C.

In another variation of the present invention, the controller is configured to terminate the energy delivery if said TM averaged over a time window exceeds TS by a fixed temperature difference. The fixed temperature difference may be a value between 1 and 10° C. or 5° C. The time window is between 1 and 5 seconds or 2 seconds.

In another variation of the present invention, the controller is configured to terminate if the measured temperature drops by 10 or more ° C. in a sample period such as 1.0 seconds or 0.2 seconds.

Another variation of the present invention is a method for treating a lung by transferring energy from an active region of an energy delivery apparatus to an airway wall of the lung. The energy delivery apparatus includes a flexible elongate body and a distal section and the active region is located in the distal section. The energy delivery apparatus further has a temperature sensor located in the distal section for measuring a temperature (TM) of said airway wall and the method comprises the following steps: setting a preset temperature (TS); determining a power set point (Pi) to deliver energy from the active region to the target medium; measuring the TM using the temperature sensor, and determining a new power set point (Pi+1) based on an error (e) between the preset temperature (TS) and the measured temperature (TM) using a PID algorithm.

In yet another variation of the present invention, a process for transferring energy to a target medium using an energy delivery apparatus is provided. The energy delivery apparatus includes a flexible elongate body and a distal section wherein the distal section includes an expandable basket with at least one active region for transferring energy to the target medium. The energy delivery apparatus further has a temperature sensor located in the distal section for measuring a temperature (TM) of the target medium. The process comprises the following steps: setting a preset temperature (TS); determining a power set point (Pi) to deliver energy from the active region to the target medium; measuring TM using the temperature sensor; and determining a new power set point (Pi+1) based on an error (e) between the preset temperature (TS) and the measured temperature (TM) using an algorithm having a variable gain factor. The energy may be delivered to an airway wall of a lung in vivo, in vitro or to another target such as a sponge or towel which may be moistened with saline solution. Saline solution increases the conductivity of the target.

In one variation of the present invention, the algorithm is Pi+1=Pi+G (αei+βei−1+γei−2) where α, β and γ are preset values: α is from 1 to 2; β is from −1 to −2; and γ is from −0.5 to 0.5. In another variation of the present invention, α, β, γ are 1.6, −1.6, and 0.0 respectively.

In another variation of the present invention, the gain factor is reset 0.1 to 2 seconds after energy delivery has begun. The gain factor can also be reset 0.5 seconds after energy delivery has begun. The invention includes resetting G to 0.9 to 1.0 if a temperature rise in ° C. per Joule is less than or equal to 2.5; 0.4 to 0.5 if a temperature rise in ° C. per Joule is between 2.5 to 5.0; to 0.2 to 0.3 if a temperature rise in ° C. per Joule is equal to 5.0 to 7.5; and to 0.1 to 0.2 if a temperature rise in ° C. per Joule is greater than 7.5. Initially, the gain factor is equal to 0.4 to 0.5 and preferably 0.45 to 0.47.

In another variation of the present invention, the energy delivery is terminated if the energy delivered exceeds a maximum energy such as 120 joules.

In another variation of the present invention, energy is delivered for an activation time period such as 0 to 15 seconds, 8 to 12 seconds, or 10 seconds.

In another variation of the present invention, TS is set at a value between 60 to 80, or 65° C.

In another variation of the present invention, impedance is measured and energy delivery is terminated when the impedance drops below a preset impedance value such as 40 to 60 ohms.

In another variation of the present invention, the energy is terminated if TM exceeds TS by a pre-selected value such as 10, 15 or 20° C.

In another variation of the present invention, energy is terminated if the output power is greater or equal to a nominal output power and TM drops by a critical temperature difference within a sampling period. In variations of the present invention, the nominal output power is set at a value of at least 17 watts; the sampling period is set at a value of at least 0.5 seconds; and the critical temperature difference is 2° C.

In another variation, the energy delivery apparatus is configured to deliver an amount of power up to a maximum power. The maximum power can be from 10 to 40 watts and preferably from 15 to 20 watts.

In another variation of the present invention, energy delivery is terminated if TM averaged over a time window exceeds TS by a fixed temperature difference. The fixed temperature difference may be a value between 1 and 10° C. or 5° C. The time window is between 1 and 5 seconds or 2 seconds.

In another variation of the present invention, the energy delivery is terminated if the measured temperature drops by 10 or more ° C. in a sample period such as 1.0 seconds or 0.2 seconds.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will now be described in greater detail with reference to the various embodiments illustrated in the accompanying drawings:

FIG. 1 is a block diagram of a feedback loop of the present invention.

FIG. 2A is a cross sectional view of a medium sized bronchus in a healthy patient. FIG. 2B is a cross sectional view of a bronchiole in a healthy patient.

FIG. 3 is a cross sectional view of the bronchus of FIG. 2A showing the remodeling and constriction occurring in an asthma patient.

FIG. 4 is an illustration of the lungs being treated with a device and controller according to the present invention.

FIG. 5A is an illustration of an energy delivery device in accordance with the present invention.

FIGS. 5B-5D show a partial view of a thermocouple attached to a basket leg in accordance with the present invention.

FIG. 6 is a side cross sectional view of a device having a balloon with electrodes positioned exterior to the balloon.

FIGS. 7-8 illustrate examples of energy transfer elements of a device.

FIG. 9 is an illustration of a variation of a device with electrodes and a biasing element.

FIG. 10 is a schematic side view of the lungs being treated with a treatment device according to the disclosure.

FIG. 11 is a cross sectional side view of another variation of a device having a plurality of wire shaped electrodes with a deployment wire attached to a distal tip of the device.

DETAILED DESCRIPTION

The present invention includes a controller and an energy deliver apparatus to deliver energy to the airway walls of the lungs. Amongst other features, the controller includes a feedback loop having a variable gain factor as diagramed in FIG. 1. The system is useful in treating asthma and various symptoms of reversible obstructive pulmonary disease. Examples of suitable applications and methods are disclosed in International Application No. PCT/US00128745 filed Oct. 17, 2000.

The present invention is particularly useful in treating lung tissue. This is surprising in view of the unique and complicated structure of lung tissue. Referring first to FIGS. 2A and 2B, a cross section of two different airways in a healthy patient is shown. The airway of FIG. 2A is a medium sized bronchus having an airway diameter D1 of about 3 mm.

FIG. 2B shows a section through a bronchiole having an airway diameter D2 of about 1.5 mm. Each airway includes a folded inner surface or epithelium 10 surrounded by stoma 12 and smooth muscle tissue 14. The larger airways including the bronchus shown in FIG. 2A also have mucous glands 16 and cartilage 18 surrounding the smooth muscle tissue 14. Nerve fibers 20 and blood vessels 24 surround the airway. The airway is thus quite different from other tissues such as blood vessel tissue which does not include such folds, cartilage or mucous glands. In contrast, FIG. 3 illustrates the bronchus of FIG. 2A in which the smooth muscle 14 has hypertrophied and increased in thickness causing the airway diameter to be reduced from the diameter D1 to a diameter D3. Accordingly, the airways to be treated with the device of the present invention may be 1 mm in diameter or greater, more preferably 3 mm in diameter or greater.

FIG. 4 is an illustration of the lungs being treated with a system 36 according to the present invention. The system 36 includes a controller 32 and an energy treatment device 30 which may be an elongated member as described further below. The device 30 also includes an expandable distal section which can be positioned at a treatment site 34 within a lung or another target medium. In operation, the device is manipulated to the treatment site 34. RF energy, for example, is delivered through the energy delivering device and penetrates the surface of the lung tissue such that tissue is affected below the epithelial layer as well as on the surface of the lung tissue.

Energy Delivering Device

As indicated above, the present invention includes a controller 32 and a device 30 through which it delivers energy to the target medium 34. A device 30 of the present invention should be of a size to access the bronchus or bronchioles of the human lung. The device may be sized to fit within bronchoscopes, preferably, with bronchoscopes having a working channel of 2 mm or less. The device may also include a steering member configured to guide the device to a desired target location. For example, this steering member may deflect a distal tip of the device in a desired direction to navigate to a desired bronchi or bronchiole.

The energy delivering apparatus 30 typically includes an elongate body having a proximal section and a distal section. The distal section features a radially expandable basket having a plurality of legs. The legs may be electrodes or have an active region defined by an insulated covering which contacts the medium to be treated. The basket is expanded with an actuator mechanism which may be provided in a handle attached to proximal end of the elongate body. Examples of energy delivering devices in accordance with the present invention are described in co-pending U.S. application Ser. No. 09/436,455 filed Nov. 8, 1999 which is hereby incorporated by reference in its entirety.

FIG. 10 is a schematic side view of the lungs being treated with a treatment device 1030 according to the present invention. The treatment device 1030 is an elongated member for delivery of energy from an energy source 1032 to a treatment site 1034 within the lungs. The energy may be delivered by the treatment device 1030 in a variety of treatment patterns to achieve a desired response. The energy which is delivered by the treatment device 1030 may be any of a variety of types of energy including, but not limited to, radiant, laser, radio frequency, microwave, heat energy, or mechanical energy (such as in the form of cutting or mechanical dilation). In addition, the delivery of laser or light energy may be in conjunction with the delivery of a photodynamic agent, where the laser or light energy stimulates the photodynamic agent and initiates a cytotoxic, or cell damaging chemical reaction.airways yet small enough to pass in and out of a bronchoscope.

The treatment devices include tissue contacting electrodes configured to be placed within the airway. These devices can be used for delivering radio frequency in either a monopolar or a bipolar manner or for delivering other energy to the tissue, such as conducted heat energy from resistively heated electrodes. For monopolar energy delivery, one or more electrodes of the treatment device are connected to a single pole of the energy source 1032 and an optional external electrode 1044 is connected to an opposite pole of the energy source. For bipolar energy delivery, multiple electrodes are connected to opposite poles of the energy source 1032 and the external electrode 1044 is omitted. The number and arrangement of the electrodes may vary depending on the pattern of energy delivery desired.

FIG. 11 illustrates a variation of the device 1304 having a basket 1104 comprising of four legs 1106. It is preferred that the legs 1106 are spaced at equal intervals around the expandable member or basket 1104. For example, in variations of the invention having four legs 1106, the legs 1106 are preferably, but not necessarily spaced at approximately 90 degree intervals around the basket 1104. In variations having five legs 1106, the legs 1106 may be spaced at approximately 72 degree intervals. Other variations of the invention include devices having less than four legs or more than five legs. It is thought that the most effective number of legs is a compromise based on the size of the target airway, contact surface between the leg 1106 and airway wall, and the maximum outer diameter of the elongated member 1102.

FIG. 11 illustrates a variation of a device 1304 having basket legs 1106 connected to a distal end 1114 of the elongated member 1102 and forming a basket 1104. In this variation, a proximal joint is found at the distal end 1114 of the elongated member 1102. The basket 1104 is expanded radially, to its second state, during use to ensure contact between the energy transfer elements (not shown) and the airway walls (not shown) by, for example, pulling on a center pull wire 1116 which is connected to a distal tip 1118 of the expandable member 1104. The center pull wire 1116 may extend through a lumen of the elongated member 1102 towards a proximal portion (not shown) of the elongated member 1102. It is also contemplated that the center pull wire 1116 may be configured to deliver current to the energy transfer elements found on the expandable member 1104. The device 1304 may be delivered to a treatment site through a delivery sheath 1120 and may be drawn along or moved axially along the airway to treat the airway in a pattern of longitudinal or helical stripes.

Temperature Sensor

The invention also includes a temperature detecting element. Examples of temperature detecting elements include thermocouples, infrared sensors, thermistors, resistance temperature detectors (RTDs), or any other apparatus capable of detecting temperatures or changes in temperature. The temperature detecting element is preferably placed in proximity to the expandable member.

FIG. 5A is a partial view of a variation of the invention having thermocouple 137 positioned about midway along basket leg 106. FIG. 5B is an enlarged partial view of the thermocouple 137 of FIG. 5A showing the leads 139 separately coupled on an inwardly-facing surface of the leg 106. Consequently, the basket leg itself is used as part of the thermocouple junction upon which the temperature measurement is based. In other words, the thermocouple junction is intrinsic to the basket leg. This configuration is preferred because it provides an accurate temperature measurement of tissue contacting the leg 106 in the vicinity of the thermocouple leads. In contrast, typical thermocouple configurations consist of a thermocouple junction offset or extrinsic to the basket leg. We believe that thermocouple junctions having an offset from or extrinsic to the basket leg do not measure temperature as accurately in certain applications as thermocouple junctions which are intrinsic to the basket leg.

The leads 139 may be placed at other locations along the leg 106 including an edge 405. Joining the leads 139 to the edge 405, however, is undesirable because of its relatively small bonding surface.

FIG. 5B also shows basket leg 106 having an outer insulating material or coaling 410. The boundaries 415 of the insulating material 410 define an uninsulated, active section of electrode leg 106 which delivers energy to the tissue walls. Preferably, the insulating coating 410 is heat shrink tubing or a polymeric coating. However, other insulating materials may be used.

FIGS. 5C and 5D show another variation of the present invention having thin foil or laminated thermocouple leads 139. The thermocouple leads 139 are configured as foils or layers which can be, for example, prefabricated foils or sputtered films. Suitable materials for the thermocouple leads (listed in pairs) include, but are not limited to: Constantan and Copper; Constantan and Nickel-Chromium; Constantan and Iron; and Nickel-Aluminum and Nickel-Chromium. The thermocouple pair, CHROMEL and ALUMEL (both of which are registered trademarks of Hoskins Manufacturing) is preferred. CHROMEL and ALUMEL is a standard thermocouple pair and has been shown to be biocompatible and corrosion resistant in our applications. The thermocouple leads 139 may be placed such that each lead approaches the center of the basket leg from an opposite end of the basket leg. The leads 139 then terminate in bond joints 440 and 450. Alternatively, as shown in the configuration of FIG. SD, both thermocouple leads 139 may run from the same end of the basket leg 106.

Preferably, insulating layers 430 and 440 are disposed between the thin film leads 139 and the basket leg 106. The insulating layers 430 and 440 electrically separate the leads 139 as well as electrically separate the leads from the leg 106. The insulating layers 430 and 440 limit the thermocouple junction to bond joints 450 and 460, which are optimally positioned on active region 420 of basket leg 106.

Controller

The present invention includes a controller which controls the energy to be delivered to the airways via an energy transfer device. The controller includes at least one of the novel features disclosed hereinafter and may also incorporate features in known RF energy controllers. An example of a RF generator which may be modified in accordance with the present invention is the FORCE™ 2 Generator manufactured by Valleylab, Boulder, Colo., U.S.A. Another suitable technique to generate and control RF energy is to modulate RF output of a RF power amplifier by feeding it a suitable control signal.

The controller and power supply is configured to deliver enough energy to produce a desired effect in the lung. The power supply should also be configured to deliver the energy for a sufficient duration such that the effect persists. This is accomplished by a time setting which may be entered into the power supply memory by a user.

The power supply or generator of the present invention can also employ a number of algorithms to adjust energy delivery, to compensate for device failures (such as thermocouple detachment), to compensate for improper use (such as poor contact of the electrodes), and to compensate for tissue inhomogeneities which can affect energy delivery such as, for example, subsurface vessels, adjacent airways, or variations in connective tissue.

The power supply can also include circuitry for monitoring parameters of energy. transfer: (for example, voltage, current, power, impedance, as well as temperature from the temperature sensing element), and use this information to control the amount of energy delivered. In the case of delivering RF energy, typical frequencies of the RF energy or RF power waveform are from 300 to 1750 kHz with 300 to 500 kHz or 450 to 475 being preferred. The RF power-level generally ranges from about 0-30 W but depends upon a number of factors such as, size of the electrodes. The controller may also be configured to independently and selectively apply energy to one or more of the basket leg electrodes.

A power supply may also include control modes for delivering energy safely and effectively. Energy may be delivered in open loop (power held constant) mode for a specific time duration. Energy may also be delivered in temperature control mode, with output power varied to maintain a certain temperature for a specific time duration. In the case of RF energy delivery via RF electrodes, the power supply may also operate in impedance control mode.

Temperature Control Mode

In a temperature control mode, the power supply may operate up to a 75° C. setting. That is, the temperature measured by the thermocouple can reach up to 75° C. before the power supply is shut off. The duration must be long enough to produce the desired effect, but as short as possible to allow treatment of all of the desired target airways within a lung. For example, up to 15 seconds is suitable, and more preferably 8 to 12 seconds with about 10 seconds per activation (while the device is stationary) being preferred. Shorter duration with higher temperature will also produce an acceptable acute effect.

It should be noted that different device constructions utilize different parameter settings to achieve the desired effect. For example, while direct RF electrodes typically utilize temperatures up to 75° C. in temperature control mode, resistively heated electrodes may utilize temperatures up to 90° C.

Energy Pulses and Energy Modulation

Short bursts or pulses of RF energy may also be delivered to the target tissue. Short pulses of RF energy heat the proximal tissue while the deeper tissue, which is primarily heated by conduction through the proximal tissue, cools between the bursts of energy. Short pulses of energy therefore tend to isolate treatment to the proximal tissue.

The application of short pulses of RF energy may be accomplished by modulating the RF power waveform with a modulation waveform. Modulating the RF power waveform may be performed while employing any of the other control algorithms discussed herein so long as they are not exclusive of one another. For example, the RF energy may be modulated while in a temperature control mode.

Examples of modulation waveforms include but are not limited to a pulse train of square waves, sinusoidal, or any other waveform types. In the case of square wave modulation, the modulated RF energy can be characterized in terms of a pulse width (the time of an individual pulse of RF energy) and a duty cycle (the percent of time the RF output is applied). A suitable duty cycle can be up to 100% which is essentially applying RF energy without modulation. Duty cycles up to 80% or up to 50% may also be suitable for limiting collateral damage or to localize the affect of the applied energy.

Feedback Algorithm

As indicated above, the present invention includes controllers having various algorithms. The algorithms may be either analog and digital based. A preferred embodiment is a three parameter controller, or Proportional-Integral-Derivative (PID) controller which employs the following algorithm: Pi+1=Pi+G (αei+βei−1+γei−2) where Pi+1 is a new power set point, Pi is a previous power set point, α, β and γ are preset values, G is a variable gain factor and ei, ei−1, ei−2 correspond to error at the present time step, error one step previous and error two steps previous where the error is the difference between the preset temperature and a measured temperature.

We have found that by using a variable gain factor (G) to adaptively control RF energy delivery, the system of the present invention can treat a wide range of tissue types including lung tissue bronchus, bronchioles and other airway passages. The variable gain factor scales the coefficients (alpha, beta, and gamma; each a function of the three PID parameters) based on, for example, the temperature response to energy input during the initial temperature ramp up.

Exemplary PID parameters are presented herein, expressed in alpha-beta-gamma space, for an energy delivering device and controller of the present invention. These settings and timings are based on testing in various animal lung tissues using an energy delivering apparatus as described above. First, the gain factor preferably varies and is reset 0.1 to 2 and more preferably at 0.5 seconds after energy delivery has begun. Preferably, the gain factor is reset as follows: G is reset to 0.9 to 1.0 and preferably 0.9 if a temperature rise in ° C. per Joule is less than or equal to 2.5; G is reset to 0.4 to 0.5 and preferably 0.5 if a temperature rise in ° C. per Joule is between 2.5 to 5.0; G is reset to 02 to 03 and preferably 0.2 if a temperature rise in ° C. per Joule is equal to 5.0 to 7.5; and G is reset to 0.1 to 0.2 and preferably 0.1 if a temperature rise in ° C. per Joule is greater than 7.5. We have also found that a suitable value for α is from 1 to 2; for β is from −1 to −2; and for γ is from −0.5 to 0.5. More preferably α, β, γ are 1.6, −1.6, and 0.0 respectively.

It is also possible to change the relative weights of alpha, beta, and gamma depending upon monitored temperature response working in either PID or Alpha-Beta-Gamma coordinate space beyond just scaling the alpha-beta-gamma coefficients with a variable gain factor. This can be done by individually adjusting any or all of alpha, beta, or gamma.

In another variation of the present invention, the PID algorithm is Pi+1=Pi−(G1ei+G2ei−1+G3ei−2) and G1, G2 and G3 are variable gain factors. The invention includes configuring the controller such that G1, G2 and G3 are reset to 0.90 to 2.00, −0.90 to −2.00 and 0.50 to −0.50 respectively if a temperature rise in ° C. per Joule is less than or equal to 2.5; to 0.40 to 1.00, −0.40 to −1.00 and 0.25 to −025 respectively if a temperature rise in. ° C. per Joule is between 2.5 to 5.0; to 0.20 to 0.60, −0.20 to −0.60 and 0.15 to −0.15 respectively if a temperature rise in ° C. per Joule is equal to 5.0 to 7.5; and to 0.10 to 0.40, −0.10 to −0.40 and 0.10 to −0.10 respectively if a temperature rise in ° C. per Joule is greater than 7.5. Each of the variable gain factors may be equal to a product of at least one preset value and at least one variable value.

It is also possible to employ an algorithm that continuously adapts to signals rather than at discrete sample steps, intervals or periods. The algorithm takes into account several variables upon which observed temperature response depends including, for example: initial temperature, time history of energy delivery, and the amount of energy required to maintain set point temperature. An exemplary analog PID algorithm is: u=KPe+KI∫edt+KD (de/dt) where u is a signal to be adjusted such as, for example, a current, a voltage difference, or an output power which results in energy delivery from the electrode to the airway wall. KP, KI and KD are preset or variable values which are multiplied with the proper error term where e(t) is the difference between a preset variable and a measured process variable such as temperature at time (t). The above equation is suitable for continuous and/or analog type controllers.

Power Shut Down Safety Algorithms

In addition to the control modes specified above, the power supply may include control algorithms to limit excessive thermal damage to the airway tissue. Damage may be limited by terminating or shutting down the energy being delivered to the target medium. The algorithms can be based on the expectation that the sensed temperature of the tissue will respond upon the application of energy. The temperature response, for example, may be a change in temperature in a specified time or the rate of change of temperature. The expected temperature response can be predicted as a function of the initially sensed temperature, the temperature data for a specified power level as a function of time, or any other variables found to affect tissue properties. The expected temperature response may thus be used as a parameter in a power supply safety algorithm. For example, if the measured temperature response is not within a predefined range of the expected temperature response, the power supply will automatically shut down.

Other control algorithms may also be employed. For example, an algorithm may be employed to shut down energy delivery if the sensed temperature does not rise by a certain number of degrees in a pre-specified amount of time after energy delivery begins. Preferably, if the sensed temperature does not increase more than about 10° C. in about 3 seconds, the power supply is shut off. More preferably, if the sensed temperature does not increase more than about 10° C. in about 1 second, the power supply is shut off.

Another way to stop energy delivery includes shutting down a power supply if the temperature ramp is not within a predefined range at any time during energy delivery. For example, if the measured rate of temperature change does not reach a predefined value, the power supply will stop delivery of the RF energy. The predefined values are predetermined and based on empirical data. Generally, the predefined values are based on the duration of time RF energy is delivered and the power-level applied. A suitable predefined rate of temperature change to stop energy delivery is from 8° C./second to 15° C./second in the first 5 seconds (preferably in the first 2 seconds) of commencing energy delivery.

Other algorithms include shutting down a power supply if a maximum temperature setting is exceeded or shutting down a power supply if the sensed temperature suddenly changes, such a change includes either a drop or rise, this change may indicate failure of the temperature sensing element. For example, the generator or power supply may be programmed to shut off if the sensed temperature drops more than about 10° C. in about 0.1 to 1 seconds and more preferably in about 0.2 seconds.

In another configuration, the power is terminated when the measured temperature exceeds a pre-selected temperature or exceeds the set point temperature by a pre-selected amount. For example, when the set point is exceeded by 5 to 20° C., more preferably 15° C. the power will terminate.

In another configuration, power is terminated when the measured temperature (averaged over a time window) exceeds a pre-selected temperature. For example, power may be terminated when the measured temperature (averaged over 1 to 5 seconds and preferably averaged over 2 seconds) exceeds the preset temperature by a predetermined amount. The predetermined amount is generally from 1 to 10° C. and preferably about 5° C. Suitable preset temperatures are from 60 to 80° C. and most preferably about 65° C. Accordingly, in one exemplary configuration, the power is stopped when the measured temperature (averaged over 2 seconds) exceeds 70° C.

In another configuration, the power is terminated when the amount of energy delivered exceeds a maximum amount. A suitable maximum amount is 120 Joules for an energy delivery apparatus delivering energy to the airways of lungs.

In another configuration, the power is shut down depending on an impedance measurement. The impedance is monitored across a treated area of tissue within the lung. Impedance may also be monitored at more than one site within the lungs. The measuring of impedance may be but is not necessarily performed by the same electrodes used to deliver the energy treatment to the tissue. The impedance may be measured as is known in the art and as taught in U.S. application Ser. No. 09/436,455 which is incorporated by reference in its entirety. Accordingly, in one variation of the present invention, the power is adjusted or shut off when a measured impedance drops below a preset impedance value. When using the energy delivering device of the present invention to treat airways, a suitable range for the preset impedance value is from 40 to 60 ohms and preferably about 50 ohms.

In another variation, the energy delivery apparatus is configured to deliver an amount of power up to a maximum power. The maximum power can be from 10 to 40 watts and preferably from 15 to 20 watts.

In yet another configuration, the power supply is configured to shut down if the power delivered exceeds a maximum power and the measured temperature drops by a critical temperature difference within a sampling period of time. A suitable maximum power is from 15 to 20 Watts and preferably about 17 watts. The sampling period of time ‘generally ranges from 0.1 to 1.0 seconds and preferably is about 0.5 seconds. A suitable range for the critical temperature difference is about 2° C.

It is to be understood that any of the above algorithms and shut-down configurations may be combined in a single controller. However, algorithms having mutually exclusive functions may not be combined.

While the power supply or generator preferably includes or employs a microprocessor, the invention is not so limited. Other means known in the art may be employed. For example, the generator may be hardwired to run one or more of the above discussed algorithms.

The controller is preferably programmable and configured to receive and manipulate other signals than the examples provided above. For example, other useful sensors may provide input signals to the processor to be used in determining the power output for the next step. The treatment of an airway may also involve placing a visualization system such as an endoscope or bronchoscope into the airways. The treatment device is then inserted through or next to the bronchoscope or endoscope while visualizing the airways. Alternatively, the visualization system may be built directly into the treatment device using fiber optic imaging and lenses or a CCD and lens arranged at the distal portion of the treatment device. The treatment device may also be positioned using radiographic visualization such as fluoroscopy or other external visualization means.

Examples

A system to treat airways in accordance with the present invention was built and tested in vivo on two canines. The system included an energy delivering apparatus having a distal basket. The basket included electrode legs and a temperature sensor mounted to one of the legs. The system also included a generator programmed to measure the temperature change per energy unit during the first half-second of treatment. A PID gain factor was adjusted depending on the measured tissue response. That is, the gain factor was adjusted based on the temperature change per joule output during the first half second. In general, this corresponds to a higher gain for less responsive tissue and lower gain for more responsive tissue.

After treating the test subjects with a general anesthetic, RF energy was delivered to target regions using an energy delivery device and generator as described above. In particular, energy activations were performed on all available intraparenchyma 1 airways three millimeters or larger in diameter in both lungs. Three hundred sixty-three activations using a 65° C. temperature setting were performed in the two animals (i.e., 180 activations per animal). Additionally, in twenty of the activations in each animal, the energy delivery device was deliberately deployed improperly to provide a “Stress” condition.

In each activation, the measured temperature reached and stabilized at 65° C. or, in the case of the twenty activations under “stress” conditions, the power properly shut off. Thus, the present invention can successfully treat lung tissue with a variable gain setting and various safety algorithms to safely maintain a preset temperature at the electrode or lung tissue surface. This temperature control is particularly advantageous when treating the airways of lungs to reduce asthma symptoms.

Additional Examples

FIG. 6 illustrates a device 1306 in which an expandable member comprises a balloon member 1150. Device 1306 includes electrodes 1154 positioned on an exterior surface of the balloon member 1150. The electrodes 1154 may be connected to an energy source (not shown) by leads 1156 extending through the balloon and through the lumen of an elongated member 1102. The balloon member 1150 may be filled with a fluid 1152 such as saline or air to bring the electrodes 1154 into contact with the airway wall 1000. As noted above, the electrodes may also be resistance heating elements, RF electrodes, or another suitable element for conducting energy transfer with the airway. Also, a single electrode may continuously surround a circumference of a balloon 1150, or a plurality of electrodes may be spaced at certain intervals to substantially surround the circumference of a balloon 1150.

Turning now to the energy transfer elements located on an expandable portion, FIGS. 7-8 illustrate examples of energy transfer elements that may be located on an expandable portion of a device. In the variation of the invention where the expandable portion comprises a basket having basket legs 1106, the basket legs 1106 may function as heat exchange elements. In other words, the device may be configured so that the leg is an electrode or the conductive heating element. In these variations, the leg 1106 may be partially covered with an insulation only leaving an active region exposed for delivery of energy to the airways. Examples of such insulation include a heat shrink sleeve, a dielectric polymeric coating, or other material which may function as an insulator.

FIG. 7 illustrates an example of a basket leg 1106 with an energy transferring element 1132 coiled around the leg 1106. In this example, the energy transferring element uses conductive heating and comprises a resistance heating element 1132 coiled around the leg 1106. FIG. 8 illustrates a variation of the invention having an RF electrode attached to the basket leg 1106. The RF electrode may be attached to the basket leg 1106 via the use of a fastener 1134. For example, the electrode may be attached via the use of a heat shrink fastener 1134, (e.g., polymeric material such as PET or polyethylene tubing).

FIG. 9 illustrates a variation of an inventive device 1318 having one or more electrodes 1178 connected to a distal end of an elongated tube 1102. The electrodes 1178 are supported between the distal end of the elongated tube 1102 and a distal tip 1180. A connecting shaft 1182 supports the tip 1180. Also connected between the distal end of the elongated member 1102 and the distal tip 1180 is a spring element 1184 for biasing the electrodes 1178 against a wall of the airway. The spring element 1184 may have one end which slides in a track or groove in the elongated member 1102 such that the spring 1184 can flex to a variety of different positions depending on an internal diameter of the airway to be treated.

This invention has been described and specific embodiments or examples of the invention have been portrayed to convey a proper understanding of the invention. The use of such examples is not intended to limit the invention in any way. Additionally, to the extent that there are variations of the invention which are within the spirit of the disclosure and are equivalent to features found in the claims, it is the intent that the claims cover those variations as well. All equivalents are considered to be within the scope of the claimed invention, even those which may not have been set forth herein merely for the sake of brevity. Also, the various aspects of the invention described herein may be modified and/or used in combination with such other aspects also described to be part of the invention either explicitly or inherently to form other advantageous variations considered to be part of the invention covered by the claims which follow.

The invention described herein expressly incorporates the following co-pending applications by reference in their entirety: U.S. application Ser. No. 09/095,323; U.S. application Ser. No. 09/095,323; U.S. application Ser. No. 09/349,715; U.S. application Ser. No. 09/296,040; U.S. application Ser. No. 09/436,455; and U.S. application Ser. No. 09/535,856. 

The invention claimed is:
 1. A system for delivering energy to a medium, comprising: an expandable member including a plurality of energy delivery elements spaced 90 degrees from one another about a longitudinal axis of the expandable member, wherein a first energy delivery element of the plurality of energy delivery elements includes an exposed active region defined at first and second ends by insulating material, and the plurality of energy delivery elements includes exactly four energy delivery elements; at least one temperature sensor for measuring a temperature (T_(M)) of the medium or at least one of the energy delivery elements when energy is delivered to the medium; a PID controller for determining a new power set point (P_(i+1)) based on an error at a present time step (e_(i)) between a preset temperature (T_(S)) and the measured temperature (T_(M)), and an error at a previous time step (e_(i−1)) between the preset temperature (T_(S)) and the measured temperature (T_(M)), wherein the PID controller is configured to terminate energy delivery when the measured temperature does not increase by at least 10° C. in an initial 3 seconds from an initiation of energy delivery.
 2. The system of claim 1, wherein the PID controller also determines the new power set point (P_(i+1)) based on an error at two previous time steps (e_(i−2)), the PID controller also determines the new power set point (P_(i+1)) based on a previous power set point (P_(i)), the PID controller applies an algorithm having a variable gain factor (G), the algorithm is P_(i+1)=P_(i)+G(αe_(i)+βe_(i−1)+γe_(i−2)), and α, β and γ are preset values.
 3. The system of claim 2, wherein α is from 1 to 2, β is from −1 to −2, and γ is from −0.5 to 0.5.
 4. The system of claim 2, wherein the controller is configured such that G is reset 0.1 to 2 seconds after energy delivery has begun, to 0.9 to 1.0 if a temperature rise in ° C. per Joule is less than or equal to 2.5, to 0.4 to 0.5 if a temperature rise in ° C. per Joule is from 2.5 to 5.0, to 0.2 to 0.3 if a temperature rise in ° C. per Joule is from to 5.0 to 7.5, or to 0.1 to 0.2 if a temperature rise in ° C. per Joule is greater than 7.5.
 5. The system of claim 2, wherein the variable gain factor (G) is initially equal to a value from 0.4 and 0.5.
 6. The system of claim 1, wherein the PID controller also determines the new power set point (P_(i+1)) based on an error at two previous time steps (e_(i−2)), the PID controller determines the new power set point (P_(i+1)) based on a previous power set point (P_(i)), and the PID controller applies an algorithm having a plurality of variable gain factors, wherein the algorithm is P_(i+1)=P_(i)+(G₁e_(i)+G₂e_(i−1)+G₃e_(i−2)) where G₁, G₂ and G₃ are variable gain factors, the controller is configured such that the variable gain factors are reset 0.1 to 2 seconds after energy delivery has begun, the controller is configured such that G₁, G₂ and G₃ are reset to 0.90 to 2.00, −0.90 to −2.00 and 0.5 to −0.5, respectively, if a temperature rise in ° C. per Joule is less than or equal to 2.5, are reset to 0.40 to 1.00, −0.40 to −1.00 and 0.25 to −0.25, respectively, if a temperature rise in ° C. per Joule is from 2.5 to 5.0, are reset to 0.20 to 0.60, −0.20 to −0.60 and 0.15 to −0.15, respectively, if a temperature rise in ° C. per Joule is from to 5.0 to 7.5, are reset to 0.10 to 0.40, −0.10 to −0.40 and 0.10 to −0.10, respectively, if a temperature rise in ° C. per Joule is greater than 7.5, and each of the variable gain factors is equal to a product of at least one preset value and at least one variable value.
 7. The system of claim 1, wherein the controller is configured: such that the energy delivery is terminated if the energy delivered exceeds 120 joules; to deliver energy for an activation time period up to 15 seconds; and such that T_(S) is from 60° C. to 80° C.
 8. The system of claim 1, wherein the controller is configured to measure impedance, and the energy delivery is terminated when the impedance drops below 40 to 60 ohms.
 9. The system of claim 1, wherein the controller is configured to terminate the energy delivery if the T_(M) exceeds T_(S) by 10° C. to 20° C., or if the measured temperature drops by 10 or more ° C. in a sample period from 0.2 to 1.0 seconds.
 10. The system of claim 1, wherein the expandable member is configured to deliver an amount of power up to 10 to 40 watts.
 11. The system of claim 1, wherein the insulating material covers conductive portions of the first energy delivery element.
 12. The system of claim 1, wherein the PID controller is further configured to terminate energy delivery when the measured temperature changes by at least 10° C. in a time period from 0.1 to 1 seconds at any point during energy delivery.
 13. The system of claim 1, wherein the PID controller is configured to terminate energy delivery when the measured temperature does not increase by at least 10° C. in an initial 1 second from the initiation of energy delivery.
 14. A system for delivering energy to a medium, comprising: an energy source configured to generate radiofrequency energy; an expandable basket including a plurality of radiofrequency electrodes disposed about a longitudinal axis of the expandable basket, wherein one or more of the plurality of radiofrequency electrodes are coupled to a first pole of the energy source; an external electrode coupled to a second pole of the energy source, the second pole being opposite the first pole; at least one temperature sensor for measuring temperature (T_(M)) of the medium or a radiofrequency electrode of the plurality of radiofrequency electrodes when energy is delivered to the medium; and a PID controller for determining a new power set point (P_(i+1)) based on an error (e) between a preset temperature (T_(S)) and the measured temperature (T_(M)), wherein the controller is configured to terminate the energy delivery if the output power is greater than or equal to a nominal output power and the T_(M) drops by a critical temperature difference within a sampling period, and is configured to terminate energy delivery when the measured temperature changes by at least 10° C. in a time period from 0.1 to 1 seconds at any point during energy delivery.
 15. The system of claim 14, wherein the nominal output power is at least 15 watts, the sampling period is at least 0.5 seconds, and the critical temperature difference is 2° C.
 16. The system of claim 14, wherein: the expandable basket further includes a distal tip distal to each of the plurality of radiofrequency electrodes; distal ends of the plurality of radiofrequency electrodes converge toward the distal tip; each of the plurality of radiofrequency electrodes is curved; and the expandable basket includes exactly four radiofrequency electrodes spaced 90 degrees from one another about a central longitudinal axis of the expandable basket.
 17. The system of claim 16, further including a wire extending from proximal of a proximal end of the expandable basket, through an interior volume defined by the plurality of radiofrequency electrodes, to the distal tip, wherein applying a proximal pulling force on the wire causes the plurality of radiofrequency electrodes to radially expand, and releasing the proximal pulling force causes the plurality of radiofrequency electrodes to radially contract, and the wire is configured to deliver current to each of the plurality of radiofrequency electrodes.
 18. The system of claim 17, wherein: each of the plurality of radiofrequency electrodes includes an exposed active region defined at first and second ends by an insulating material covering conductive portions of the respective radiofrequency electrode; the at least one temperature sensor includes a thermocouple with two leads coupled to the exposed active region of one of the plurality of radiofrequency electrodes; and the exposed active region of the radiofrequency electrode coupled with the two leads forms a thermocouple junction with the two leads upon which temperature measurement is based.
 19. A system for delivering energy to a medium, comprising: a treatment device including a basket having a plurality of radiofrequency electrodes circumferentially spaced about a longitudinal axis of the treatment device for delivering energy to the medium, the plurality of electrodes converging at a distal tip, at least one of the radiofrequency electrodes including an exposed electrically conductive portion extending from a first end toward a second end; a first nonconductive region coupled to the first end of the exposed electrically conductive portion; a second nonconductive region coupled to the second end of the exposed electrically conductive portion; a member extending from proximal of a proximal end of the basket, through an interior volume defined by the plurality of radiofrequency electrodes, to the distal tip, wherein applying a proximal pulling force on the member causes the plurality of radiofrequency electrodes to radially expand, and releasing the proximal pulling force causes the plurality of radiofrequency electrodes to radially contract, and the member is configured to deliver current to each of the plurality of radiofrequency electrodes; and at least one temperature sensor for measuring temperature (T_(M)) of the medium or the at least one radiofrequency electrode when energy is delivered to the medium; a PID controller for determining a new power set point (P_(i+i)) based on an error (e) between a preset temperature (T_(S)) and the measured temperature (T_(M)); and wherein the controller is configured to terminate the energy delivery if the T_(M) averaged over a time window exceeds T_(S) by a fixed temperature difference, and is configured to terminate energy delivery when the measured temperature changes by at least 10° C. in a time period from 0.1 to 1 seconds at any point during energy delivery.
 20. The system of claim 19, wherein the fixed temperature difference is from 1 and 10° C., and wherein the time window is from 1 and 5 seconds. 